Healthcare delivery
disruptions such as industrial action, and that further recovery is still possible, particularly through technology-enabled change. However, NHSE was unable to convince the Committee that it has a detailed plan to achieve the promised productivity gains, and it does not yet fully measure and capture productivity in important areas, such as mental health and community services. Recommendation: NHSE should set out in detail which specific actions and initiatives it expects to contribute to the unprecedented increase in productivity it has committed to, and by how much. This should include specific measures to address poor staff retention and sickness rates, which contribute to low productivity.
Tackling health in deprived areas 4. In some cases, NHSE’s payment mechanisms can mean that local systems do not receive financial recognition when they prioritise hard-to-reach patients. GP surgeries receive a payment for every child vaccination. This vaccination funding mechanism favours areas where parents are more willing to inoculate their children, while areas with higher levels of vaccine hesitancy, which may be more deprived areas, receive less funding and therefore have fewer resources to carry out much-needed activities such as outreach and education, potentially leading to even fewer patients being vaccinated in those areas. NHS Providers notes that tackling wider determinants of health must involve the specific targeting of poor health in the most deprived areas.
Recommendation: NHSE should review
current payment systems and processes to ensure they incentivise local systems to work with those most in need of help.
Re-focusing attention from sickness to prevention 5. Given the constraints on public spending, it is highly likely that re-focusing attention from sickness to prevention cannot be achieved without re-allocating existing NHS funds in the same direction. Senior ICB leaders report a continued lack of progress with the government’s long-standing aim to move towards preventing ill health rather than treating it. Furthermore, the public health grant used
by local authorities to commission preventative measures such as health-visiting and drug and alcohol services is expected to fall in value by £193 million (5%) over the period 2022–23 to 2024–25 (at 2022–23 prices), despite government’s commitment in 2021 to maintain it in real terms. However, DHSC does not view providing more
resources for prevention as a substantive part of the solution. Instead, it considers that a shift towards prevention might be achieved through longer-term legislative and culture change to tackle issues such as obesity, physical activity and poor air quality alongside a shift in the way GPs advise patients. Both DHSC and NHSE see the 10-year health plan as an opportunity to crystallise their prevention ambitions, but the lack of a precise definition of what even counts as prevention spending will make assessing progress against this vital policy aim impossible. Local areas
would value more flexibility about where they can direct their resources to achieve greatest impact, including how they fund measures to prevent ill health. Recommendation: DHSC, NHSE and HMT should define what counts as health prevention spending for the whole of government within the next six months, and track that spending annually, using 2024–25 as a baseline year DHSC and NHSE should also set out the funding increases required for prevention and give local systems the flexibility and autonomy they need to direct this funding where it can have the greatest impact.
Moving care from hospitals to the community NHSE’s long-held ambition to move more care from hospitals to the community has stalled, according to the Committee. It says that there would have been more investment and progress in mental health and community services, particularly GP surgeries and dental services, in 2023–24, had NHSE not “redirected funding to prop up the day-to-day spending of local NHS systems”. Despite carrying out 15% more elective activity compared to before the pandemic, the NHS is less productive overall once the activities of mental health Trusts, community Trusts and GPs are considered. NHSE makes trade- offs between spending that will yield benefits in the longer term and spending to meet current priorities, and it acknowledges funding increases for mental health and community services are slow. NHSE recognises there is value in considering
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